An Uncommon Complication of an Aortic Valve Replacement

Acute myocardial infarction after an isolated aortic valve replacement is uncommon. An iatrogenic coronary dissection during coronary cannulation should be kept in mind, and the diagnosis and management of this complication are challenging in such a setting. The patient under analgesia is usually free of symptoms, and the interpretation of troponin elevation during the postoperative period could be complex. We herein describe a male patient who showed a cardiogenic shock and an electrical storm a few hours after an isolated aortic valve surgical operation. Transthoracic and transesophageal echocardiographic examinations demonstrated a very low left ventricular systolic function, no sign of prosthesis dysfunction, and no sign of aortic dissection. Coronary angiography revealed an extensive coronary artery dissection. This dissection concerned the left main and the entire left anterior descending artery. A bailout stenting was performed successfully. We herewith discuss the technical aspects of the management of this case and explain the mechanism of this complication.